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Hodgkins Lymphoma PowerPoint Presentation

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Description : Hodgkins Lymphoma

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Published on : Aug 15, 2023 | Views : 3377 | Downloads : 17

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Prepared and Presented by: Dr. Nirav S. Panchal Assistant Professor, Dept. of Pathology, GMERS Medical College, Vadnagar. HODGKIN’S LYMPHOMA & NON- HODGKIN’S LYMPHOMA
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Leukemia Vs. Lymphoma Leukemia is used for lymphoid neoplasm presenting with widespread involvement of the bone marrow, accompanied by presence of tumor cells in peripheral blood. Lymphoma is used to describe proliferations arising as discrete tissue masses. It is malignant tumor of lymphoreticular origin (from lymphocyte)
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Lymphoma Hodgkin’s lymphoma/Disease Non hodgkin’s lymphoma Plasma cell neoplasms
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WHO Classification of Lymphoid Neoplasms As per WHO classification all lymphoid neoplasms fall into following 5 categories: I. Hodgkin’s disease II. Precursor (Immature) B-cell malignancies III. Peripheral (Mature) B-cell malignancies IV. Precursor (Immature) T-cell malignancies V. Peripheral (Mature) T-cell and NK–cell malignancies
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WHO Classification of Lymphoid Neoplasms Non – Hodgkin’s Lymphoma
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WHO Classification of Lymphoid Neoplasms Non – Hodgkin’s Lymphoma
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WHO Classification of Lymphoid Neoplasms B. Hodgkin’s Lymphoma Classic Nodular sclerosis Lymphocytic rich Mixed cellularity Lymphocytic depletion Nodular lymphocytic predominant
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Hodgkin’s Lymphoma Definition “Hodgkin lymphoma" (HL), encompasses a group of lymphoid neoplasms that: arise in a single node or chain of nodes spread first to the anatomically contiguous nodes are characterized morphologically by the presence of neoplastic giant cells called Reed- Sternberg (RS) cells or it’s variants
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whose predominant component is comprised of non-neoplastic inflammatory cells (reactive lymphocytes, plasma cells, histiocytes, eosinophils and neutrophils).
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Hodgkin’s Lymphoma Incidence HL comprise 20-30% of all malignant lymphomas and 8% of all cases of lymphoid neoplasms. The incidence of the disease has bimodal peaks— one in young adults between the age of 15 and 35 years and the other peak after 5th decade of life. The HD is more prevalent in young adult males than females.
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Hodgkin’s Lymphoma Classification Rye’s classification WHO Central to the diagnosis of HD is the essential identification of Reed-Sternberg cell.
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WHO Classification
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Hodgkin’s Lymphoma Etiopathogenesis EBV Genetic factors: certain HLA B18 types, identical twins Cytokines: IL-5, IL-13, TGF - β
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Reed – Sternberg Cells It is neoplastic giant cell. Hallmark of HD is presence of RS cell. It comprises only 1-5% of total tumor mass. It is derived from germinal centre or post germinal centre B cell. It induces the accumulation of reactive lymphocytes, histiocytes & tissue eosinophils.
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Reed – Sternberg Cells Characteristics Giant cell with a bi-lobed nucleus as if mirror image of each other. Each lobe of the nucleus contains a prominent, eosinophilic, inclusion like nucleolus with a clear halo around it, giving an owl-eye appearance. The cytoplasm of cell is abundant and amphophilic.
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RS Cell – Histological variants
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RS Cell – Histological variants
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RS Cell – Histological variants
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RS Cell – Histological variants
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RS Cell – Histological variants
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Hodgkin’s Disease subtypes A. Nodular Sclerosing Incidence: most common form of HL, constituting 65% to 70% of cases Clinical features: affect adolescents or young adults males and females are affected equally has propensity to involve the lower cervical or supraclavicular, with mediastinal lymph nodes most present in stage I/II
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Hodgkin’s Disease subtypes - Nodular Sclerosing Morphology: there is diffuse effacement of the nodal architecture by collagen bands dividing lymphoid tissue into circumscribed nodules. shows “lacunar variant” of the RS-cells. Classic RS-cells are less frequent. non-neoplastic inflammatory component is comprised of small lymphocytes, eosinophils, plasma cells, and macrophages. large geographic areas of necrosis are often seen. RS cells may also show necrosis, presence of mummified variant. IHC: CD45-, CD5-, CD20-, CD15+, CD30+, EBV Prognosis: excellent
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Hodgkin’s Disease subtypes - Nodular Sclerosing
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Hodgkin’s Disease subtypes - Nodular Sclerosing
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Hodgkin’s Disease subtypes – Mixed Cellularity B. Mixed Cellularity Incidence constitute about 20% to 25% of cases Clinical manifestations biphasic incidence, peaking in young adults and again in adults older than 55 years more common in males Sub-diaphragmatic disease is more common patients generally present in advanced tumor stage III/IV
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Hodgkin’s Disease subtypes – Mixed Cellularity Morphology: characterized by diffuse effacement of lymph node architecture by a heterogeneous cellular infiltrate of small lymphocytes, eosinophils, plasma cells, and macrophages admixed among them are plentiful number of classic RS-cells and their mononuclear variant. IHC: CD45-, CD5-, CD20-, CD15+, CD30+, 70% EBV+ Prognosis: not as favourable as “Nodular-Sclerosing” and “Lymphocyte-Predominant”
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Hodgkin’s Disease subtypes – Mixed Cellularity
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Hodgkin’s Disease subtypes – Mixed Cellularity
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Hodgkin’s Disease subtypes - Lymphocyte – Rich C. Lymphocyte – Rich Incidence: uncommon form of Classic HL Clinical features: Older adults (median age 43 years) M >F Presents in stage I/II Mediastinal involvement is common
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Hodgkin’s Disease subtypes - Lymphocyte – Rich Morphology: lymph nodes are diffusely effaced, but vague nodularity may be seen presence of frequent mononuclear and classic RS- cells monomorphic inflammatory infiltrate, comprised of reactive lymphocytes IHC: CD45-, CD5-, CD20-, CD15+, CD30+, 40% EBV+ Prognosis: very good to excellent
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Hodgkin’s Disease subtypes - Lymphocyte – Rich
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Hodgkin’s Disease subtypes - Lymphocyte – Depleted D. Lymphocyte – Depleted Incidence: Least common form of HL, amounting to < 5% of cases. Clinical features: Older patients More commonly seen in HIV-positive individuals peripheral lymphadenopathy is common in “Reticular form” and BM involvement in “diffuse fibrosis type” Sub diaphragmatic disease or organomegaly is common presents in advanced stage
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Hodgkin’s Disease subtypes - Lymphocyte – Depleted Morphology: Characterized by paucity of lymphocytes and a relative abundance of pleomorphic variants of RS-cells IHC: CD45-, CD5-, CD20-, CD15+, CD30+, most EBV+ Prognosis: overall outcome is somewhat less favourable than other subtypes
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Hodgkin’s Disease subtypes - Lymphocyte – Depleted
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Hodgkin’s Disease subtypes – Nodular Lymphocyte – Predominance Incidence: uncommon variant, accounting for approximately 5% of all cases Clinical features: majority of patients are males usually younger than 35 years of age present with cervical or axillary lymphadenopathy mediastinal and bone marrow involvement is rare
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Hodgkin’s Disease subtypes – Nodular Lymphocyte – Predominance Morphology: characterized by nodal effacement by expanded B-cell follicles follicles are comprised by small lymphocytes admixed with variable numbers of histiocytes lymphohistiocytic (L&H) variants ("popcorn cell"). IHC: CD20+, CD15-, CD30-, BCL6+, EBV Prognosis: excellent Recurrence is more likely than the classical subtypes 3% to 5% of cases transform to diffuse large B-cell lymphoma
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Hodgkin’s Disease – Clinical Features Hodgkin’s disease is particularly frequent among young and middle-aged adults. All histologic subtypes of HD, except the nodular sclerosis variety, are more common in males. The disease usually begins with superficial lymph node enlargement and subsequently spreads to other lymphoid and non-lymphoid structures.
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Hodgkin’s Disease – Clinical Features Painless lymphadenopathy Cervical/Mediastinal> Axillary, inguinal & abdominal Splenomegaly & Hepatomegaly Constitutional Symptoms/Type B symptoms: Night sweats Low grade fever Weight loss Fatigue, malaise, weakness, pruritus
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Hodgkin’s Disease – Laboratory Findings Hematological Anemia – Normocytic, Normochromic WBC – leukemoid reaction Advanced disease is associated with absolute lymphopenia. Platelets – normal or increased ESR – elevated Bone marrow – infiltration causing marrow failure: leucoerythroblastic reaction S. Iron and TIBC are decreased but marrow iron stores are normal or increased.
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Hodgkin’s Disease – Laboratory Findings Immunological: Defective cellular immunity Fall in T cell count reversal of CD4: CD8 ratio Humoral antibody production is normal in untreated patients until late in the disease.
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Hodgkin’s Disease – Staging
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Hodgkin’s Disease – Staging Investigations done for complete staging Documentation of B symptoms Physical examination Chest X-ray; CT abdomen & pelvis CBC,RFT, LFT B/L bone marrow biopsy; IHC for typing Lymphangiography of lower extremities Staging laprotomy biopsy of selected lymph nodes in the retroperitoneum spleenectomy wedge biopsy of the liver.
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Hodgkin’s Disease – Prognosis HD is now curable in most cases. Cure rate for stages I and IIA is close to 90%. Even with advanced disease (stages IVA and IVB), 60% to 70% 5-year disease-free survival is obtained. Mixed-Cellularity type and Lymphocyte-Depleted type are associated with less favourable prognosis.
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Long-term survivors of chemotherapy and radiotherapy have an increased risk of developing second cancers: 1. Myelodysplastic syndromes 2. AML 3. lung cancer 4. NHL 5. breast cancer 6. gastric cancer 7. sarcoma 8. malignant melanoma
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HL Vs. NHL
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THANK YOU KEEP READING